Views From a Western Acupuncturist in Hong Kong

An interesting development in health care is occurring all over the world. Natural and traditional medicine, most notably acupuncture, are entering the marketplace in a big way.

Two major reasons drive this new integration.

First, consumers are increasingly demanding freedom in choosing the therapies they wish to receive. Second, there is pressure on both the institutional and individual levels to reduce the costs of health care, which in the U.S. represent 17 percent of the country's gross national product. Let's look at both of these issues.

Today's consumers are becoming increasingly knowledgeable about their own health and the range of health care options available to them. In advanced multiracial and multicultural societies like those in Hong Kong, Europe and the U.S., people are exposed to a variety of ethnic and traditional therapies in addition to Western medicine. A recent study of acupuncture patients in the U.S. performed by Claire Cassidy, PhD, revealed that on average, people were seeing three to four providers in a six-month period, including MDs, psychologists, physiotherapists and other specialists. People believe that for a variety of conditions, they need a variety of practitioners.

Drugless approaches are also gaining in popularity as people look for long-lasting solutions to their health problems. A recent U.S. study reported by Harvard University indicated that given the option of two equally effective medications for a particular condition, one pharmaceutical and one plant-derived, more than half of the respondents would choose the natural or plant-derived treatment.

Holistic means of healing, which involve the patient's active participation and which respect the interaction between mind and body, are becoming increasingly appealing. The people for whom these approaches are most appealing are the very highly educated. In the Cassidy study on patient satisfaction with acupuncture treatment, 22 percent were college graduates and a whopping 51 percent had postgraduate education or postgraduate degrees. A significant plurality of the subjects in this study, when asked to which of their providers they gave the most credit for their improvement, stated that their acupuncturist "was the one who made the difference." Fifty-seven percent said that their improvement was "definitely" due to acupuncture, 19.9 percent said it was "probably" due to acupuncture, and only 17.5 percent said was "due to a combination of factors." It should be noted that respondents were also generally satisfied with Western medical treatment; however, fewer respondents reported that they were "very" or "extremely" satisfied with their medical doctors.

This ringing endorsement of acupuncture deserves a careful look at the reasons behind it. Ninety-one percent of the respondents reported a "disappearance" or "improvement" of symptoms after acupuncture treatment. Seventy-nine percent said they used fewer prescription drugs. Seventy percent of the people who stated they had been advised to have surgery said that they were able to avoid it. Nearly all of the respondents reported that acupuncture helped them feel better and function better. A significant number stated that they had more energy and enthusiasm, and that the felt more comfortable socially. Many reported that they got along better with others, that they liked their co-workers more, and that they were able to control their tempers better. Patients also reported that rather than seeing symptoms as an "illness" or the "failure" of medical or self-care, they began to see them as friendly warnings that they were overstepping the boundaries of their strength. Respondents praised their acupuncturists for instructing them in practical self-care and described them with terms such as "friend," "guide," "coach" or "partner."

Another reason for patient satisfaction is that acupuncture does some things better than Western medicine. Between 50 percent and 70 percent of the conditions for which people consult MDs are subclinical; that is, they are not diseases at all. They are items like fatigue, weight gain, sluggish digestion, headaches, and free-floating anxiety.

Subclinical issues are the bread and butter of natural healing. We focus on preserving health, preventing disease, and treating imbalances and disorders in the incipient stage. We are better at listening to and instructing patients, and inducing them to make the lifestyle changes necessary to prevent the recurrence of problems.

In addition, we treat many conditions more effectively or at a lower cost than conventional medicine. For example, musculoskeletal injuries including athletic, auto and work injuries, and repetitive stress injuries like carpal tunnel syndrome, are often treated more effectively and less expensively with acupuncture, and often obviate the need for surgery. In addition, acupuncture has proved its usefulness in the problems that accompany and complicate traumatic injuries such as headache, tinnitus, sexual dysfunction and depression.

Acupuncture has been demonstrated to speed recovery after surgery, temporary ischemic attack and stroke. Smoking and substance abuse are often treated successfully with acupuncture. Finally, acupuncture is a cost-effective treatment for the whole range of subclinical issues involving subjective states and quality of life, including energy levels, clarity of thought, memory, premature aging, and emotional and spiritual balance.

The Economics of Acupuncture

Having looked at the reasons for patient satisfaction, let's now look at the economics of acupuncture.

The cost of health care is astronomical for societies as a whole, and is potentially devastating for individuals and families. The biomedical model of Western medicine, which asserts that diseases have external causes, has led to the development of increasingly expensive technological weapons against disease. This focus, which does not look at the natural healing methods of disease, has led to crippling expenditures. It has also limited the population that can afford high-end Western medical care. At the same time, the overuse of antibiotics in certain conditions has led to bacteria that are resistant to antibiotic actions. A more sound approach may be the application of strategies to strengthen the immune system to minimize opportunistic infections.

A rethinking of the whole concept of illness and how to treat it has resulted. One example is how insurance companies, which must make determinations as to what health care services are appropriate for their clients, have responded to the necessity to include complementary practitioners. Many patients who have sustained severe trauma are prescribed pain relievers, mood elevators and muscle relaxants for extended periods. Iatrogenic, or hospital-induced, addictions sometimes result. Because of the documented effectiveness of acupuncture in treating addictive disorders, the Hawaii Workers' Compensation Board has authorized payment for acupuncture treatment. The reductions in costs to the insurance system and to the private pain of the patient can be considerable.

Alternative and complementary medicine are already big business in the United States. A study published in the New England Journal of Medicine in January 1993 by Dr. David Eisenberg of Harvard Medical School found that in 1990, Americans made an estimated 425 million visits to complementary medicine providers. In contrast, they made only 388 million visits to medical doctors. Spending for complementary care was estimated at $14 billion in 1990 and $18 billion in 1993, most of it out-of-pocket. This represents explosive growth. Because of its cost-effectiveness, acupuncture is fully reimbursable under the no-fault auto insurance and workers' compensation programs of many states in the U.S. Because of consumer demand, lower costs per visit, intense competition among insurers for customers, and insurers' expectations of future cost savings, many private insurance carriers offer coverage for acupuncture and many other forms of complementary medicine.

Other influences leading to the mainstreaming of complementary medicine are the growing body of scientific date linking disease to nutritional and emotional factors, and the increasing sophistication of consumers who know the efficacy and utility of other cultures' medicines. In addition, "baby boomers" in particular have a healthy disregard for authority, paternalism and conformity, and have the money to pay for what they want.

The acknowledgement of cost savings and effectiveness of natural medicine, and of consumer demand, have led to similar developments in the United Kingdom, the European Union, Thailand and China. Here in Hong Kong, the Chinese University of Hong Kong, Hong Kong University and Baptist University all began degree programs in traditional Chinese medicine in 1998, based on recommendations from a government-appointed preparatory committee.

In short, a new maturity and common sense is evolving in the field of health care. The day is not far off when the exercise of freedom of choice and the integration of alternative and complementary medicine into the health care delivery system will be part of the established order.

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